List of recent legal technical assistance requests and answers.

A requester contacted the Network noting that it is a misdemeanor for pharmacists to sell drug paraphernalia in his state and that there were also no needle exchange sites in the state. Limited access to drug paraphernalia may increase the likelihood that intravenous drug users will share needles, increasing the spread of diseases like HIV and hepatitis C. The requester wanted to know if other states have similar laws and what strategies for harm reduction have been used in those states.

A policy analyst for a local health district contacted the Network for assistance in researching model health resolutions. Reviewing examples of resolutions is an excellent way for local boards of health and local governments to benefit from the knowledge and experience of other communities and public health leaders. In the course of the Network’s research to collect sample resolutions, several categories of resolutions emerged.

Mobile devices are frequently used to access, share, or communicate information about an individual’s or a patient’s health records or status. Any mobile device that receives, transmits or stores protected health information (PHI) must comply with the Health Insurance Portability and Accountability Act (HIPAA). A staff person from a local health department recently contacted the Network about whether other public health agencies have stand-alone HIPAA policies that specifically address mobile device usage.

The Network was recently asked to provide recommendations on published research articles, policy statements or briefs, fact sheets, or other published material assessing laws or policies that implement universal early childhood education (e.g. "pre-Kindergarten" starting at 3 years of age).

A requester recently contacted the Network for guidance and clarification on who is permitted to prescribe naloxone directly or via standing order in Wisconsin. Specifically, the requester wanted to know the prescriber authority and criminal liability for advanced practice nurses versus registered or licensed nurse practitioners.

A climate and health specialist contacted the Network for information about resources related to preemption of local laws by states, specifically state-level preemption of bans on the use of plastic bags by grocery stores, convenience stores and other establishments.

All 50 states and the District of Columbia have now modified their laws to increase access to naloxone, a drug that can reverse the effects of an overdose to heroin or other opioid painkillers. The Network was recently asked about the number of states in which naloxone can be purchased “over the counter”. While there are a wide variety of steps that states, localities, and private businesses can take to increase access to naloxone, they cannot make it available “over the counter” or “without a prescription.”

The Network was recently contacted by a policy analyst at a state health department about whether there were known best-practices or resources that focus on zoning ordinances, requirements, or incentives for developers that encourage biking through the creation of bikes lanes, the installation of bike racks and similar initiatives in new housing developments. The Network provided the requester with information on several resources, evaluative tools and sample ordinances on biking.

A requestor in Michigan recently contacted the Network with concerns regarding animal control management since stray and wild animals can pose a public health threat. Animal bites can spread rabies and some animals can cause injuries. Because the county in which the requester lived lacked funding for an animal control agency, the requester wanted to know who is responsible for providing animal control and animal quarantine services.

Opioid overdose is at epidemic levels in the United States. It is estimated that over 33,000 Americans lose their lives from opioid overdose. Opioid overdose mortality is preventable with the timely administration of naloxone and the provision of emergency medical care. Naloxone is a prescription medication, making it difficult for the drug to be readily available by those who need it. In response, many states have made an effort to reduce barriers to accessing naloxone.

A requestor recently contacted the Network with several questions regarding naloxone access.

A requester recently contacted the Network to ask how states regulate the use of human waste as a fertilizer. Both federal and state law allow for the use of human waste as an agricultural fertilizer. The land application of biosolids, sewage sludge, and/or domestic septage provides considerable nutrient benefits for the soil, but also presents a range of health and environmental challenges.

Naloxone blocks or reverses the effects of opioids and can save the life of someone overdosing if given in a timely manner. A public health professional recently asked the Network if it is legal for a layperson to distribute naloxone injection equipment in Texas. And whether pharmacists in Texas are liable for selling injection equipment if they suspect the person will use it to inject drugs.

The use of pesticides on cannabis plants has increasingly become a health concern in states that have legalized marijuana, and regulations can be murky. The Network recently received a request from an individual looking for information on state regulations related to pesticide application on cannabis plants.

A requestor in Simi Valley, California recently asked the Network whether pet animals, such as dogs, were allowed in retail food facilities, such as grocery stores and restaurants. The Network researched the issue and provided the requestor with two resources.

The Network recently received a request from a county health officer for information about youth marijuana use rates, and specifically about whether youth use rates were higher in states with medical marijuana laws (MMLs) than states where marijuana use remained illegal.

The Vaccines for Children Program (VFC) is a federally-funded program in the United States providing no-cost vaccines to children who lack health insurance or who cannot otherwise afford the cost of vaccination. A public health worker from Arizona recently contacted the Network asking several questions about the VFC Program and insurance coverage.

A healthcare administrator recently contacted the Network asking for resources on the applicability and requirements of the Family Education Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in relation to the sharing of students’ immunization information.

A Michigan requestor recently asked the Network for resources and court opinions pertaining to the exclusion of unvaccinated children from school during a disease outbreak. The Network found two cases and one state Attorney General opinion relevant to the issue.

A physician who participates on an asthma workgroup recently contacted the Network about potential legal issues related to keeping and distributing lists of students with health concerns in a school setting. Specifically, the requestor wanted to know the considerations involved in having schools create lists of students who suffer from asthma to distribute to teachers, coaches, bus drivers and other staff. This list would help staff be prepared to respond in case of an asthma attack.

A healthcare provider from Rhode Island recently contacted the Network for information on the differences, if any, between privacy protections for pharmacy records and prescription drug monitoring program (PDMP) records in law enforcement investigations.

A requestor from Washington state recently asked the Network for information on the conditions under which Nurse Practitioners (NPs) and Physician Assistants (PAs) can prescribe buprenorphine for treatment of opioid use disorder (OUD).

A trauma prevention specialist at a major Massachusetts hospital recently contacted the Network looking for information on law in their state regarding firearm access by those convicted of domestic violence. Specifically, the requestor asked for information regarding the so-called “boyfriend loophole,” a result of the legal definition of a “domestic” relationship in many states that does not include dating partners—that is, couples who never married, never cohabitated, or do not have children.

A requestor recently contacted the Network for information about the differences and similarities in the regulation of pain clinics and marijuana dispensaries in Michigan. The Network located guidelines for pain treatment and reporting requirements for opioids and other controlled substances, and identified the Michigan statutes and laws that govern the use and distribution of medical marijuana as well as the licensing and regulation of medical marijuana facilities.

The Network was recently contacted by a requester who asked for information about effective state approaches for regulating pain clinics. Pain clinics that frequently provide inappropriately large quantities of prescriptions are often called “pill mills,” and these facilities have been implicated in the proliferation of both prescription opioid and heroin overdose deaths. States have primary responsibility for regulating prescription drug practice and pain clinics.

Federal laws restrict the use of federal funds for lobbying activities. The Network was recently contacted by a public health officer asking for clarification on the distinction between lobbying and advocacy. Broadly, the use of federal funding cannot “…influence an officer or employee of any agency or Congressional member/staff regarding federal awards.” But a more accurate answer is more complex. The Network provided the public health officer with several additional resources to provide clarification on the issue.

A requestor from Arizona contacted the Network for information on the legality of testing an individual suspected of being HIV positive without his or her consent. Health care providers in Arizona must obtain informed consent prior to testing individuals for HIV, unless an exception applies.

A local health department in Maryland recently asked the Network for guidance on whether state law preempted a local ordinance restricting the sale of tobacco products to minors. The issue isn’t simple or clear. While the State has the authority to preempt or preclude local jurisdictions from enacting local laws dealing with the same issue, this does not mean that counties cannot regulate in an area just because the State already has enacted a law on that issue.

A requestor from Illinois recently contacted the Network asking if a county or multi-county health department in that state has the legal authority to lease a portion of its building to another entity. Illinois law provides that a county or multi-county board of health may lease county property with the approval of the County Board or if authorized by ordinance or resolution.

Under the Health Insurance Portability and Accountability Act (HIPAA), a health provider or other covered entity may be required or allowed to disclose protected health information to third parties without the authorization or agreement of the patient - but what are the patient's rights?

A health scientist at a national public health organization recently contacted the Network for information about states that have instituted drug overdose review teams. A number of states have committees at the state or local level to review child drug fatalities, but only four states have legislation authorizing overdose fatality review panels.

Vitamin K shots are recommended for newborns to protect them from Vitamin K Deficiency Bleeding. A public health analyst recently contacted the Network for information about Oregon’s and other states’ statutes and codes addressing administration of vitamin K to newborns.

Do county governments have the authority to pass a sales tax to be used in support of public health operations? In Illinois, some counties are granted general authority with limitations on what can be taxed; other counties have limited authority to impose a sales tax, but only if the tax is approved by voters.

A requestor contacted the Network for information on how HIV reporting is included in states’ communicable disease reporting rules, specifically those states that do not have standalone rules specific to HIV reporting, but instead include HIV reporting in general disease reporting requirements. The Network provided the requestor with two resources related to HIV reporting laws across the United States.

Opioid overdoses are typically reversible through the timely administration of the medication naloxone and the provision of emergency care. The Network was recently contacted by a requestor who asked about liability for the administration of naloxone by law enforcement officers in Louisiana.

Public health surveillance is the ongoing systematic collection, analysis and interpretation of health and other data to inform public health efforts. The Network was recently contacted by a requestor from a state health department planning to conduct blood testing for health surveillance purposes. The requestor had several questions about informed consent related to the testing and associated questionnaires for participants, as well as retention and storage of the health information collected.

The Network was contacted by a public health official in Arizona about the legal authority that state (or local) government has to abate public health nuisances, specifically related to potential breeding sites for disease-carrying mosquitoes. In Arizona, health authorities can order the removal or destruction of a public health nuisance in two primary ways, and specific abatement powers and processes may be altered pursuant to formal declarations of emergency or public health emergency.

A county health department in the process of updating its regulations on body art ― piercings, tattoos, scarification ― contacted the Network for information about regulations in other jurisdictions that define, prohibit, or allow for more unusual forms of body art such as tongue bifurcation (in which the tongue is permanently altered by cutting it centrally from its tip), suspension (hoisting a person into the air via body piercings), and subdermal implants (the insertion of foreign objects under the skin to achieve artistic effects).

A drug overdose prevention advocate contacted the Network with a question about the overdose prevention trainings their organization conducts in Florida. The requestor wanted to know if, at the end of the training session, they could dispense naloxone under a recently passed state law that permits naloxone to be prescribed via standing order.

A community in Wisconsin raised concerns about a brewpub that was emitting exhaust so foul that some neighbors were not able to use their back yards. The Network was asked if the problem with the exhaust could be considered a public health concern, and what laws might be relevant to the situation.

The Network received a request from a health researcher working on anonymizing health data to comply with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). The researcher asked the Network if failing to de-identify the health care provider could be seen as a violation of privacy under HIPAA.

The Network was contacted recently by a requestor who wanted more general information about Zika as well as information about emergency legal preparedness around a possible U.S. outbreak of the virus. The Network is working in real-time on these specific issues and was able to provide several helpful resources.

Epinephrine auto-injectors, also known as adrenaline, are often sold under the brand name EpiPen. It is used to treat a number of conditions, including anaphylaxis (severe allergic reaction). A requestor recently asked the Network if the state of Illinois provides immunity for those who administer epinephrine in emergency situations.

Many states have taken action to make naloxone, a medication that reverses the effects of opioid drugs, more available to the public as well as first responders. The laws regarding the prescribing and dispensing of naloxone vary by state, but most states have made efforts to make it easier for medical professionals to prescribe naloxone and for laypeople to receive naloxone for use in overdose reversal. Maine is one of the 27 states that permits naloxone to be dispensed via standing order. The Network was recently contacted by a nonprofit employee who asked for help finding the specific language of Maine’s standing order law.

"Health in all policies” (HiAP) refers to a movement within public health to consider the implications on the public’s health from all sectors of public policy, including transportation, education, agriculture, and housing. The Maryland legislature is currently considering Senate Bill 304, which would establish a Health in All Policies Commission in the state.

A requestor contacted the Network for information on the scope of practice for dental hygienists in Nebraska. The Network provided the requestor with a fact sheet for Nebraska that details the clinical dental health services as well as the public health related services dental hygienists provide.

The Network was contacted by an Indiana health care facility that provides services to pregnant women and girls. The facility has an ultrasound machine and wanted to know whether Indiana law prohibits providers from performing an ultrasound procedure on a minor without parental knowledge or consent.

Individuals seeking to become permanent residents of the United States must submit a Report of Medical Examination and Vaccination Record, or I-693 Form. The form must be completed by a federally designated civil surgeon based on the surgeon’s medical examination. The Network was recently asked if the results of an I-693 exam can be reported to local health departments.

The Network was contacted by a requester seeking information about Michigan’s return-to-play law. The requester wanted to know what sort of provision the law has for enforcing the requirements and dealing with possible violations.

State laws establish vaccination requirements for children attending public schools and often to those attending private schools. A requestor recently contacted the Network asking for clarification on the application of vaccination laws to private schools in Arizona.

The Food and Drug Administration (FDA) released guidance for generic pharmaceutical manufacturers, which recommends that generic medications have a similar appearance to the reference drug (the brand name drug of which the generic is a version). The FDA believes this practice will help decrease medication errors and increase adherence.

The Network was asked whether this guidance is legally binding, and if not, whether the FDA could make a rule on the matter, or if making the guidance legally binding would require legislation.

The Network received a request from an individual in North Carolina who asked a number of questions regarding dental hygienists and the laws governing their scope of practice in that state. The questions related to state laws governing the direct supervision of dental hygienists, practice arrangements where indirect supervision is permitted, as well as rules dealing with the operation of dental practices.

The Network was contacted by the director of a local health department in Arizona who asked for information, including model policies, regarding isolation and quarantine procedures. The Network provided the requestor with a number of resources, both general and specific to Arizona.

The Network was contacted by a state health department drug and alcohol program about whether medical record privacy rules permit or forbid an employer to ask a job applicant to disclose his or her history with drug addiction.

“Open burning,” the practice of burning refuse – often trash, leaves, or scrap wood – in the open air, is a common method of disposal but can have serious consequences for environmental safety and the public’s health. Open burning ordinances and model laws are available from several jurisdictions.

The Network was contacted for guidance on the legal and health concerns related to unaccompanied children in emergency situations. With some exceptions, under normal circumstances health care workers (HCWs) must obtain consent from parents or legal guardians in order to provide treatment to minors. However, in an emergency situation, minors may become separated from their parents or legal guardians, or health facilities may become overwhelmed and lack the resources to obtain proper consent.

The Network was recently contacted by a local health department for information — specifically examples of policy and practice from other jurisdictions — on using text messaging to communicate on matters such as immunization and appointment reminders, emergency notifications, and client care.

A requester in Maryland wanted to know if there had been any significant legislative changes to the Maryland Drunk Driving Reduction Act since its passage in 2011, or whether there had been other legislative changes in the state relevant to the issue of drunk driving.

The Network was contacted by a public health advocate in Michigan who asked if Michigan House Bill 5404, regarding naloxone, requires emergency medical technicians (EMTs) to carry naloxone when on the job.

Many minors and young adults have health insurance coverage through their parents’ plans as dependents. The Network was recently contacted by a public health researcher who asked about the tension between health information privacy for dependents and explanations of benefits (EOBs) provided by health insurers.

A public health professional recently contacted the Network for resources on how to respond to situations in which a health care worker wishes to abdicate responsibility for care of an Ebola patient or any other patient with an infectious disease.

An Arizona county public health administrator recently contacted the Network with a question regarding law enforcement and communicable diseases. Specifically, does a law enforcement agent interacting with an individual have a statutory right to know if that person poses a risk for disease transmission?

A public health advocate recently contacted the Network, concerned that a local prosecutor’s office was using possession of a condom as evidence of prostitution. The requestor was interested in working with the prosecutor’s office to change the practice and asked the Network if other areas of the country had faced similar issues.

For many low-income Americans, Medicaid provides much-needed access to health care. The Network was recently contacted by a requestor who asked for information regarding the termination of a Medicaid provider by the Centers for Medicare & Medicaid Services (CMS) in cases of Medicaid fraud, and the consequences of that termination at the state level.

Adherence to a drug regimen is critical for the treatment of tuberculosis and directly observed therapy is a method in which a health care worker or other designated individual observes a patient swallow each dose of the prescribed medication. Video directly observed therapy is a similar practice facilitated through video technology, allowing the treatment provider to observe the medication administration remotely.

Newborn screening is an important public health program that detects rare but serious genetic and metabolic disorders before symptoms appear. The Newborn Screening Saves Lives Reauthorization Act of 2014 amends the Public Health Service Act to revise and extend a grant program for screening, counseling, and other services related to heritable disorders that can be detected in newborns.

The Network was recently asked whether a school district can specifically request that parents provide details regarding their child’s absence for illness under the Family Educational Rights and Privacy Act (FERPA), and if so, what logistics would be implied in legally collecting and protecting that information.

Federal law requires that state Medicaid programs make Disproportional Share Hospital (DSH) payments to hospitals that serve a large number of Medicaid and uninsured individuals. Since the Affordable Care Act (ACA) would reduce the number of uninsured, the law mandated that DSH allotments be reduced.

Video direct observed therapy (VDOT) is a technique in which a medical professional observes a patient taking their treatment drugs remotely through video technology. The Network was recently contacted by a county public health department considering the practice as a way to care for tuberculosis patients. The health department wanted to know about laws that might impact the use of VDOT.

The Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) seeks to balance the need of public health agencies to access health data with the desire of patients for health care privacy. The Network was recently asked whether local health departments can request and obtain hospital medical records for investigating a cancer or environmental disease cluster.

The Network was recently contacted by an advocate for child and maternal health who said organizations in her state are considering proposing a bill to extend Medicaid coverage for postpartum mothers up to one year after birth.

A state representative recently contacted the Network to ask what states allow police and basic emergency medical technicians (EMTs) to carry and administer naloxone. The Network researched the issue and found that all 53 jurisdictions licensed or certified emergency medical service (EMS) personnel at the paramedic level, and all permitted paramedics to administer naloxone.

The Network was recently contacted by a local health department in Michigan about whether registered nurses can prescribe non-controlled substances under a delegation by a physician and in accordance with the physician’s standing order. The health department also asked if physicians need to personally countersign written prescriptions. Current common practice is for a registered nurse to sign and include the delegating physician’s name on the prescription.

A local health department recently contacted its state health department for guidance regarding a nanny who was exposed to pertussis, or whooping cough, while providing child care for one family, then may have exposed a second family to the disease. The nanny refuses to identify the second family and the local health department is unable to take steps to stop the spread of the disease. The Network researched the issue and provided three options for the local health department to pursue in compelling the nanny to identify the family at risk.

The Network was recently contacted by the New Hampshire Department of Environmental Services (DES). The department is interested in helping local authorities regulate well water quality in New Hampshire – specifically through local ordinances requiring water quality testing for new private wells. The DES wondered if it would be better to recommend that locals pass the ordinance based on the local health officer’s nuisance authority, or if it should recommend using the state’s building code as the basis for the ordinance.

According to the National Highway Traffic Safety Administration, helmets are about 37 percent effective in preventing motorcycle deaths and about 67 percent effective in preventing brain injuries. The Network recently received a request for information on motorcycle safety helmet laws in all 50 states.

The Network received an inquiry from a county local health department director about whether food handler training is an evidence-based public health intervention for food safety. Food handler trainings are educational programs designed to reduce the instances of food-borne illness and other food safety issues. Food training requirements differ widely by jurisdiction.

A requestor recently asked the Network for information about Ohio law and the nomination and appointment process of general health district boards of health. Boards of health are an important link between public health services and a healthy community, and laws governing board structure vary from state to state.

The Network was asked about workers’ rights in dealing with bed bugs in their workplace and in homes provided by their employer. The Network researched the issue and found that in the requestor’s state, there is no law that addresses bed bugs. However, there are a number of useful resources on bed bugs, and specifically, bed bugs in the workplace.

The McKinney-Vento Act is a federal law that provides federal funding for homeless shelter programs and stipulates protections for homeless children in the area of public education. The Network was asked how the law impacts a homeless youth’s access to school-based health services.

The Ohio Public Health Association contacted the Network for information about regulations that govern the donation of unused food by hotels and event centers to homeless shelters and other social service programs in need.

The Network was contacted by a local public health department seeking accreditation through the Public Health Accreditation Board (PHAB). The department was looking for tools to help fulfill a requirement of the accreditation process.

The Network was recently contacted by a requestor with two questions regarding response to a recent outbreak of meningitis at Princeton University. Learn more about this request and see the Network's response.

The Network was contacted by a public health practitioner with questions about the authority of the Food and Drug Administration (FDA) to regulate personal care products, particularly soap. See how the Network responded.

A public health official asked the Network for further policy information on a federal health regulation, specifically whether a local health department could qualify as a community health center by the regulations of the Health Resources and Services Administration.

A city council member seeking to address use of pesticide, herbicides, and synthetic fertilizers in the context of a comprehensive city planning process recently contacted the local health officer, who came to the Network for more information.

The Network received a question from a local health official on Medicaid expansion under the Affordable Care Act (ACA), specifically if any measures are being taken to incentivize providers to accept Medicaid.

The Network received a request from a research center studying sexuality-related health disparities. The requester wanted information on how to use research information to develop an advocacy strategy that would effect legal change to benefit the health of LGBT youth.

The Network recently received a request from a state official for any relevant resources on implementing a sugar-sweetened beverage tax. The official hoped to gather information about what legislation other states have implemented to better inform the pursuit of such legislation in her state.

The Network recently received an inquiry from a health official about whether local government zoning permits to engage in frac sand mining can include conditions or contemplate modifications that would protect public health.

The Network received a request from a local health official in California who asked for more information on how local health departments can utilize legal and policy tools to achieve public health goals within their communities.

The Network was contacted by a state official about recent changes to the Health Insurance Portability and Accountability Act (HIPAA) that were part of the HIPAA omnibus final rule, and how the changes applied to her state's health department.

The Network received a request from a health official who asked how other states regulate the practice of midwifery. Midwives are health professionals who provide care to women during pregnancy and childbirth.

The Network received a request from a local health official working on emergency preparedness issues. The official was developing plans to utilize Closed Points of Distribution (Closed PODS) during emergencies.

The Network has received a number of requests from local organizations and individuals asking for assistance in utilizing legal or policy tools to promote a public health project within their community.

A public health official from the Association of State and Territorial Health Officials (ASTHO) recently contacted the Network requesting general resources and scientific research on the relationship between hunger and food insecurity and obesity.

A state attorney asked the Network about what legal protections would apply to mutual aid agreements between state laboratories created to meet the increased demand of laboratory services during a public health emergency. The Network responded...

The Network responded to a request from a local health official on policies for sharing health data. The requestor hoped to identify best practices for sharing data that has been collected, analyzed or reported by a health department.

A local health official contacted the Network with a question about California’s Hospital Infant Feeding Act. Signed into law in October 2011, the Act requires California’s Department of Public Health to promote breastfeeding and develop model training for California hospitals.

A request was made for information about liability protections and license reciprocity for health care providers responding to emergencies across state lines and the Uniform Emergency Volunteer Health Practitioners Act (UEVHPA).

A state official consulted with the Network in preparation for a public rulemaking hearing to determine the responsibilities of local public health agencies in the official’s state. A local public health agency expressed concern that the proposed rules did not address maternal and child health services as a stand-alone core service, but rather included maternal-child services under other categories of services.

A health official investigating an outbreak of a bacterial infection in his region contacted the Network for help to determine the statutory authority of his local government to address the cause of the outbreak.

A public health practitioner with a local health department recently contacted the Network with questions regarding the responsibility of non-profit hospitals to perform community health assessments that are filed with the state health department

A public health practitioner at a state health department contacted the Network because of concerns about effectively carrying out the department’s public health surveillance and investigations while still applying HIPAA privacy regulations.

The Network was contacted over concern that an Arizona bill, if enacted, would affect the screening and potential treatment of newborns under the state newborn screening law for congenital metabolic disorders and hearing loss.

The Association of State and Territorial Health Officials (ASTHO) recently contacted the Network regarding the Healthy, Hunger-Free Kids Act of 2010, which reauthorized the National School Lunch Act and the Child Nutrition Act.

An official with a state department of health contacted the Network requesting information on whether existing federal law preempts a state legislature from adding labels warning about negative health consequences of alcohol products for human consumption.

An official from a county public health department recently asked the Network for information on how to properly distribute the results of epidemiological investigations on food borne illness outbreaks to local restaurants and patrons.